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24 Executive Briefing: ASC Infection Control & Quality Improvement Before sterilization, instruments should be decontaminated with detergent, enzyme cleaner and water. "Effective sterilization cannot occur without effective cleaning," says Dr. Miller. Sterilization should be done with an FDA approved chemical agent and flash sterilization should be kept to a minimum. Your staff should label sterilized items with the date of sterilization, the sterilizer used and the controlled conditions in which it was done. Once items are properly sterilized, it is important to follow proper storage guidelines to ensure supplies remain sterile. Your storage area should never be over 75 degrees Fahrenheit or over 75 percent humidity. All items should be kept 8" to 10" off the floor and 18" away from sprinkler heads. Avoid using cardboard, which can be accidentally penetrated. Train your staff to rotate supplies in order to track what the center has and quickly notice any compromised items. 7. Involve your physicians. Physicians, as well as your healthcare staff, need to participate in the prevention program. "There has to be an active surveillance program. This means monitoring and feedback from staff and physicians," says Dr. Peck. Require patients to give feedback so you can effectively track postoperative infec- tions. Physicians follow up with their patients and flag any potential risks. A case study revealed that Lakeland Surgical and Diagnostic Center had two physicians and an epidemiologist staffing an infection control committee. The case study found that increased physician involvement on the front end led to fewer infections. 8. Provide administrative support. Administrative support is key to maintaining effective infection prevention, and Dr. Miller and Dr. Peck suggest holding obligatory recorded staffwide meetings at least once every quarter. At these meetings, ASC administrators can outline the prevention program, highlight staff strengths, go over any areas that need improvement and discuss any updates in regulations that would necessitate a change in the program. "Each staff member is required to be present or review the recording," says Dr. Peck of physicians at his center. 9. Constantly document and track. "Tracking results is critical to demonstrating effectiveness," says Dr. Miller. Your staff should be responsible for documenting each step taken to prevent infection. "Record keeping is an absolute must. If it is not documented and written down then assume no one will believe it happened," says Dr. Peck. Two important areas to document are bacterial reduction due to employees adhering to hand hygiene protocols and the amount of time your infection control officer spends on the program at your ASC. CMS requires ASCs to maintain a four-week tracking period for infections, but for an excellent program Dr. Miller and Dr. Peck recommend a six-week tracking period. Your staff should be instructed to track all product lot numbers, from the larger items all the way down to sutures. At an ASC where patients had a soft tissue reaction to sutures, the center's staff was able to track an outbreak of patient infection back to a specific group of sutures. 10. Update the program. Your infection prevention program should be designed with adaptability in mind. Regulations and guidelines are not static and once you implement a standardized program you may need to adjust the program tailored for your ASC. "You have to have a means of evaluating and following up on your infection control policies. Revise them when indicated. They are not carved in stone and actually as things evolve there has to be a policy to update and bring everybody on board," says Dr. Peck. n 4 Challenges ASCs Face in Standardizing Infection Control & How to Overcome Them By Carrie Pallardy T .K. Miller, MD, and Chuck Peck, MD, discussed the urgent need to create and implement a standardized infection prevention program in ASCs. Though setting up a standardized program is not obstacle free, Dr. Peck explains that it "could result in less waste, more importantly fewer errors and better quality outcomes for patients, the net result being increased cost effectiveness." Here are four challenges faced by ASCs when trying to put into practice a standardized program. 1. Many different surgeons. ASCs are used by many different surgeons. Some may have an interest in the center and some may simply use the center to perform procedures, and all will have a busy schedule. Familiarizing the surgeons, not to mention the regular staff of the ASC, with a new infection prevention program can be potentially time consuming. Every new physician and staff member should have infection control included within the orientation program at the center. They should also meet with the director of the infection control program. 2. Many different subspecialties. Many ASCs are multispecialty facilities and each subspecialty is accompanied by specific habits and methods. The variance in surgeon and staff behavior can be difficult to stream- line when working toward the execution of a standardized program. If a best practice IC system is in place, the risk of infectious complications is greatly reduced and less susceptible to individual variation among subspecialties. Focus on the system, not the individuals. 3. High case turnover rate. Outpatient procedures require a high patient turn over rate. A single ASC can treat thousands of patients during the course of year. Documenting and tracking each patient and everything associated with each procedure as required for an effective infection control program takes organization and commitment. Build fail-safe mechanisms into the system. Make IC part of the culture and not just a one-time project 4. Consequent infections may involve different healthcare settings. ASCs are required to collect patient complications and hospital admissions related to surgery for their infection control program. However, patients that do acquire an infection at your ASC may not necessarily return for treatment, instead turning to a hospital or different healthcare setting. This can make it difficult to track what infections originated at your ASC and how. The advent of electronic medical records and Regional Health Information Organizations should help alleviate this concern. n CareFusion is a global corporation serving the healthcare industry with products and services that help hospitals measurably improve patient care. The company develops leading technologies and products to meet the needs of healthcare professionals and patients. For more information visit www.CareFusion.com.